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A Guide to QOF+ Processes for Primary Prevention of

1. cccccseeceseeeeeees 41 3 4 Running a search to identify the patients you will target cccseceeeees 3 3 5 Merging invite letters ccccccccccseccceeeeeeeeeeeseeeeseeeneeeseueeeeeeseeeseeeeueeneeeseeeeees 7 3 6 Documenting the dispatch of invite letters in patients medical records 8 3 7 Data entry during your CVD primary prevention appointments 0 9 3 8 Recording that patients have declined the invite ccccseceeeeeeeeeeeeeneees 13 3 9 Identifying patients who need a second third invite letter cccceeeeees 14 3 10 Identifying patients who have had a CVD Primary Prevention appointment but failed to return for fasting blood tests ccceccceeceseeeeeeeeeeeeeeneeeeseeeenees 15 Section 4 Frequently Asked Questions about Processes for CVD Prevention 16 Credits Author David Morley Contributor Shanker Vijayadeva Introduction This document provides guidance on processes for managing the QOF indicators associated with primary prevention of cardiovascular disease The QOF CVD Primary Prevention indicators are designed as far as possible to be in line with the recent NICE Guideline on Lipid Modification Cooper et al 2008 http bit ly vyG The NICE guidance recommends that initially CVD risk should be estimated using CVD risk factors already recorded in primary care electronic medical records and that people should be prioritised f
2. Open Document j The merged document will open in Microsoft Word with each merged letter appearing one after the other i e if you merged a one page letter to 200 patients you will have a 200 page document k Print the document IMPORTANT If you chose to target only a subset of your CVD at risk register you will need to repeat these steps at a later date to target the remaining subsets If you need any help performing the merge described above or if you encounter problems or require assistance with the process then please log a call with the IT Service Desk servicedesk hf pct nhs uk 020 8383 8655 3 6 Documenting the dispatch of invite letters in patients medical records The steps below describe how to add the following Read code to patients records to document that a CVD Primary Prevention invite letter has been sent out 90x1 At high risk of cardiovascular disease monitoring letter invite The process is similar to the batch processing of risk codes in Section 3 1 except we ll be merging to a search rather than to a manually generated list of patients a Goto AO Advanced Options gt BD Batch Processing b Click Y at the warning prompt c Select option A Batch Data Entry d When prompted to indicate how you ll be defining the list of patients to apply the batch processing to choose option A Generated as result of a search e Navigate to and select the search you defined in Section 3
3. Leave the options set to default fixed reminder and type a suitable reminder prompt e g On QOF CVD at risk register complete metrics Ramincer Ta Click OK On DDF CYD tek veges conplels melic y OF Cancel Your reminders have now been set up When the patient s record is viewed the reminder appears in their reminder list When the GP has completed the QOF Primary Prevention metrics the reminder can be crossed off by double clicking on it If you encounter any problems with this process then please log a call with the IT Service Desk servicedesk hf pct nhs uk 020 8383 8655 2 6 Generating Invite Letters The following steps describe how to merge the invite letter that you defined in Section 2 4 to Patient Group CVD ARR a Open the Reporting gt Patient Groups module of Vision and find the CVD ARR Group b Go to the menu option Group Applications gt Generate Recalls Patent Group c You will receive the following prompt gt CYD ARR Pte Wit Has Crd Riek 9205 d Under the section Personalised Letters click the button Add Boxall to Mediasi History Recal second wd aot curedh be 1 Create added to poherds clea festa e At the Document Merge screen click Browse and find Petscrvsisse Letters Panong ced letters val na curenty gt s Tae pinisd J EA Cisse i the template letter that you defined in Section 2 4 above
4. a Go to DT Dictionaries and Templates gt C Codes templates protocols gt E Edit Access Screen Forms Templates gt T Templates b Navigate to the template titled Primary Prevention of CVD and select it c Inthe Template Editor screen select the option I Insert Prompt and specify that you will insert the prompt above prompt A d Select option A Prompt for data to be entered into the medical record e Identify the Read Code 6C2 f Type a suitable prompt e g CVD Risk Assess g Select option B Yes No prompt h Select N for the remaining 3 prompts i Press F1 to exit from the template editor This prompt can then be used during consultation to record that the patient has attended a CVD primary prevention appointment Using the code in this way will help you identify patients that haven t had a CVD primary prevention appointment If your QOF templates have not been installed or if you encountered problems installing them or configuring them or if you require any assistance in making the modification outlined above then please log a call with the IT Service Desk servicedesk hf pct nhs uk 020 8383 8655 3 3 Setting up your CVD primary prevention invite letters In order to perform a mail merge in EMIS you will need to configure your CVD primary prevention invite letters To do this complete the following steps a Goto WP Word Processing gt N New Document IMIS Pa
5. omn 2107 1996 02 04 2001 03 12 2008 03712 2008 osr2r2o08 smoking 7 A A OZ acon S ee Exercise Diet Smoking Alcohol Examination Investigation Prescribing Active Repeat Masters Lipid requlating drugs Repeat Masters Ho relevant data available Other recorded statin information Last 10 All other Clinical Data Records Where READ CODE 8B3z OR READ CODE 3C OR READ CODE 163 OR READ CODE SB6A OR READ CODE SIT OR READ CODE 127 OR READ CODE TJC2400 OR READ CODE TJC2500 OR READ CODE U60CA00 Ho relevant data available Click here to prescribe statins Click here to prescribe other lipid requilating drugs statins not indicated Statins offered but declined If your QOF Guidelines have not been installed or if you encountered problems installing them or configuring them or if you require training on using Guidelines in Vision then please log a call with the IT Service Desk servicedesk hf pct nhs uk 020 8383 8655 2 9 Recording that patients have declined the invite If patients explicitly decline the invitation for a CVD primary prevention appointment they may be excepted using the following Read code 8IAC Vascular disease risk assessment declined Note that a patient cannot be inferred to have declined on the basis of only one invite letter Evidence of three invite letters attempted contact will be sought where a patient has been exc
6. lt Return gt if complete Patients on Steen wt oe tw lhe TSS PA the Petre Pare the CVD at risk register with a risk score gt 30 Feature pe ll OO ES Edit ing Search Parameters AS _ i gt ah B he in K a fa 4 g i ni a WATER R ok r wep Ne E e SHARED SHARED Classification Code G3 Ischaemic Heart Disease EXCLUDED no date range Classification Code C10 Diabetes mellitus EXCLUDED no date range Classification Code 662n JBS CVD risk gt 30 over 10 years SHARED no date range Jea vanities he E SCCHMVOZEPRUHEHANMoOw NER d Once you have completed defining your search press return e When prompted whether the features are correct check them and select Y f Give the search a clear title for example Age 32 74 No DM or CHD CVD Risk gt 20 g Choose a directory to store your search in such as the Regular Search File h When prompted whether to run the search select Y i The search will run in the background When it completes you will receive a prompt You have now defined a cohort of patients to whom you can merge an invite letter IMPORTANT If you chose to target only a subset of your CVD at risk register you will need to repeat these steps at a later date to target the remaining subsets If you require training on the Search and Statistics module of EMIS or if you require any assistance defining searches for QOF th
7. risk Such patients needn t have their CVD risk score coded which will ensure they do not enter the CVD at risk register d As a clinician do you want to review each patient s medical record before deciding whether to code the patient s risk score or merely take a high level overview of the scores before approving them for coding You will now have identified a list of patients in the following two groups c Patients with a 10 year CVD risk score in the range gt 20 30 Read Code 662m d Patients with a 10 year CVD risk score in the range gt 30 Read Code 662n These patients will make up your CVD at risk register and will need to have their risk score Read coded You may wish to add the codes manually in order to enable you to briefly review each record before adding the code Alternatively you may wish to use bulk code entry Vision or batch processing EMIS as described later in this document 1 2 Updating your CVD at risk register Intermittently you will wish to update your CVD at risk register in order to identify patients who a Have recently registered with the practice and are at high risk b Were not previously at high risk but whose risk has recently increased To do this you will need to re run Oberoi using the Analyse clinical data icon on the Oberoi toolbar the cog symbol J Oberoi Clinical Observations 2 5 23 EMIS LY JES Risk Ana File Actions Patient Mail Merge Help Ris
8. 4 f Specify the Data Type as option A Clinical Record g Type the Read code 90x1 At high risk of cardiovascular disease monitoring letter invite h Click N when prompted whether to add the code as an active problem i When prompted to specify the date of entry select option A The same for all the patients and accept the default date j At the confirmation prompt check the details and press Y to confirm twice The code will have been added to the medical record of all patients who were defined by your search and will appear as follows All Categories Except Biochem Haem Cytoloc A Add D Delete E Edit F Flow chart R Reactivate T Template L Linked Consultation C Category filter P Problem fi N Investigations Codes on off K Mark as Summary Date Description Episode Text Qualifiers el 6 2005 estimated date of delivery by dates 20 2 2009 At high risk cardiovascular disease monitoring letter invite 9 2 2009 No FH Hypertension 16 2 2009 Wo FH CVA Stroke 13 2 2009 Chronic kidney disease stage 3A with proteinuria This will enable you to easily run a search to identify patients who have received an invite letter within a particular period If you encounter problems or require assistance with the process then please log a call with the IT Service Desk servicedesk hf pct nhs uk 020 8383 8655 3 Data entry during your CVD primary prevention appointments Practices have been provided with templates
9. Esiin Diya aa tsen armored agunt Ire aniy Jo pau Akh g moisie oF secipjs paseris mech grs aie M ia 1E Ertak ecb ade papers aor ec cens Ine the aniy a Camesi ten f Change the Option from Include to Exclude and un tick the box Exclude patients with no record for this entity Click OK g Add a second All Other Clinical Data entity and click yes at the prompt All other Clinical Data has already been selected do you want to select it again for cross entity search h Add the following selections onto the second All Other Clinical Data entity i Read Code 662m i e CVD Risk gt 20 30 ii Read Code 662n i e CVD Risk gt 30 i Ensure that the Match All option is selected in your search screen j Your final search should look like this SEARCH New Search File Edit Maintenance Help Search Input Report Output view Group Input Group Output Search Details Selections Add Entity Report Details Add Entity Search Details E Patient Details Se Patient Details Al LDate of Birth P All other Clinical Data All ls Between T 4y INC And T 32y IHC fe All other Clinical Data 2 Matches a All other Clinical D ata Exclude Read code OF Type C10 00 Diabetes mellitus Of Type G3 00 lachaemic heart disease Read code OF Type 662m 00 JBS cardiovascular disease risk 202 up to SOP OF Type 662n 00J65 cardiovascular disease risk gt 30 over nest Hatch
10. Oberoi calculate risk scores for all patients Oberoi only calculates risk scores for patients in the age range 32 74 In addition if you have an earlier version of Oberoi than v2 6 14 it will not calculate risk scores for patients who don t have any recorded blood pressure readings in their medical record How can Oberoi calculate a risk score for patients without any BP readings or Cholesterol values in their notes In agreement with NICE Lipid Modification Guidance 2008 Oberoi uses default values where data is missing from patients notes Where patient data is missing for cholesterol an estimated risk score is calculated using default values for HDL and Total Cholesterol Where patient data is missing for BP an estimated risk score is calculated using default values for BP The default values for BP are displayed in the table below Males Females 25 34 1431 121 35 44 131 123 45 54 136 130 55 64 140 138 Please note that only a patient s systolic blood pressure reading is used in the CVD CHD risk algorithms http www pcpoh bham ac uk publichealth cardiovascular select List of Default Blood Pressures and Cholesterol Levels http www pubmedcentral nih gov articlerender fcgi artid 2244603 18 Why does our clinical systems sometimes shows different risk scores compared to estimated risk scores from Oberoi even though they use the same algorithms The reason for this is that th
11. aynisi urwe tte Kan l Pe TAA ATL A ies pen Nunda ol palas r pgi 3 Live to f jar i oe a e n pioeisrgdo w lli a An Ods ur re Poot Sura Cami O Peroa leper A ha f Click OK to return to the Group Recalls screen Peters Group TVD AFR Pte Wath yee Crd Rieck 920 g Tomerge the letters to the printer click Start adi Flacel tu Moid Hius Facs recai mina oasniy be atije In pants ceed hedory Create Panora ced Lalis ersoncbied kliss ml be urise seg or the fo loping wense cocunent Remax x wordproc Venole ov d st sst ini win da f Sjal Naba d pods nmap J a re L prorecangio N for 0 fiat Hep If you need any help performing the merge described above or if you encounter problems or require assistance with the process then please log a call with the IT Service Desk servicedesk hf pct nhs uk 020 8383 8655 2 Documenting the dispatch of invite letters in patients medical records The steps below describe how to add the following Read code to patients records to document that a CVD Primary Prevention invite letter has been sent out 90x1 At high risk of cardiovascular disease monitoring letter invite a Goto the Reporting gt Patient Groups module of Vision b Find the Group CVD ARR select it and go to the menu option Group Applications gt Generate History c You will get a History Add screen for entering the term d Enter the Read Term 90x1 and fill o
12. explicitly declined the invitation The process will be similar to the process described above in Section 3 4 and Section 3 5 except that you will need to perform a different search and you may wish to define an alternative letter template as in Section 3 3 Below is the definition and screenshot of a search to identify patients who e Are on the CVD at risk register f Have received a CVD Primary Prevention invite letter documented using the Read code 90x1 At high risk of cardiovascular disease monitoring letter invite g Have not had a CVD primary prevention appointment recorded using the Read code 6C2 Primary prevention of cardiovascular disease h Have not been excepted using the Read code 8IAC Vascular disease risk assessment declined These patients will need to be re invited Feature pe Classific Code 662m JBS CVD risk gt 20 30 over 10 years EITHER OR no date range Classification Code 662n JBS CVD risk gt 30 over 10 years EITHER OR no date range Classification Code 90x1 At high risk of cardiovascular SHARED 30 06 08 30 09 09 disease monitoring letter invite a Classification Code 6C2 Primary prevention of EXCLUDED 30 06 08 30 09 09 ame Classification Code 8IAC Vascular disease risk assessment declined Editing Search Parameters A Add Feature C Cancel Feature Insert Feature R Code Review O Alter Operator X View Exclusions D Altera Date Range Feature Date Range Operator A Currently reg
13. factors can be by selecting the appropriate line clicking the button and typing a new risk factor Previous versions of Oberoi 2 6 14 and earlier a MULTIPLICATIVE approach to compute risk scores for patients who have both a family 2 9 ES Risk Factor Adjustments the risk CVD As mee ae vi Lye 33 Pert Ve Ve Oo ee a set hack dhar Afin count L33 Edit used history risk factor and an ethnicity risk factor i e a patient with both risk factors would have their risk multiplied by 1 4 x 1 5 2 1 Some recent guidance would suggest this would lead to an overestimation of risk Later versions of Oberoi 2 6 15 and later now provide the option to choose the method of handling the calculation of multiple risk factors You can select either i Single Highest i e if patient has both FH risk factor 1 5 and Ethnicity risk factor 1 4 only 1 4 would be used this method might lead to underestimation of risk default setting on Oberoi ii Additive risk factors are individually reduced by 1 0 added together and then added back to 1 0 i e 1 4 1 0 1 5 1 0 1 0 1 9 iii Multiplication not recommended as might lead to overestimation of risk To avoid any confusion and incase any practice might be using older versions of Oberoi we are currently recommending that only the Family History risk factor should be configured Therefore Risk factors should be configured as
14. have a record of family history of CHD in first degree relatives parents brothers sisters or children of a patient CVD PREVENT 6 The percentage of patients on the Practice CVD At Risk Register whose notes have a record of family history of diabetes in first degree relatives parents siblings or children of a patient CVD PREVENT 7 The percentage of patients on the Practice CVD At Risk Register who have been offered lifestyle advice on exercise and appropriate dietary changes within the previous 15 months CVD PREVENT 8 The percentage of patients on the Practice CVD At Risk Register who have been offered statin therapy in line with 2008 NICE guidance on Lipid Modification as part of their primary prevention management strategy It is prerequisite that in order to receive payment for CVD PREVENT 1 practices have achieved the existing QOF RECORDS 11 Indicator The BP of patients aged 45 and over is recorded in the preceding 5 years for at least 65 of patients Section 1 Using the Oberoi Clinical Observations Suite to identify patients appropriate for inclusion on the CVD at risk register 1 1 Using the Oberoi Clinical Observations Suite to identify patients appropriate for inclusion on the CVD at risk register The QOF CVD At Risk Register is defined as those patients in the age range 32 74 without CHD or diabetes who have anywhere in their medical records a recorded 10 year risk of developing CVD which is
15. purely to enable the bulk addition of the CVD risk codes to patient records based on the NHS numbers extracted by Oberoi Once this has been done the two Patient Groups can be deleted and replaced with a single Patient Group based upon the standard definition of the CVD at risk register To do this complete the following steps a Open the Reporting gt Patient Groups module of Vision find the two groups you defined above and delete them b Switch to the Reporting gt Search and Reports module of Vision and click the 7 New Ad hoc search button to open the SEARCH New Search window c Add the following Selection to the Patient Details entity Date of Birth in the Range T 75y to T 32y i e people aged 32 74 Please ignore the screenshot which Utipati foge shows T 74y the correct selection encontrar oe ns Date TI NEACSA apo Dete TP HEACSA seni cove iS T 75y h Date achion sequenced of TI Dete of Bath Dale peter was socepted Dan records sent tu TP SHB Pinte coveted tre TUS gt d Add the Entity All Other Clinical Data and place the following selections on it eih ee it i Read Code C10 hierarchical i e Diabetes kaban E0 Ko Egua ii Read Code G3 hierarchical i e CHD ad GI irh hayi Sipas H Fach et Soreryee e When you return to the SEARCH New Search te has screen right click the All Other Clinical Data fone mecca mare Eee entity and select Options hat de a
16. the work load over the QOF period This might help manage capacity within the practice One approach could be to target the higher risk gt 30 patients first and then the intermediate risk gt 20 30 patients IV An alternative approach to the one above could be to target the higher risk gt 30 males first then higher risk females then intermediate risk gt 20 30 males and finally intermediate risk females Below are some screenshots of searches that enable you to break the Patient Group CVD ARR into subgroups Patients on the CVD at risk register without hypertension SEARCH New Search Fe Ect Maertenance Heb Search Input cues Report Output view hapira Gmuo Quta vD ARR Pts wih 1i roa Ovd Rak 920 amp CADAR NO H CVD at neh paient athast hypetensoan i Search Details Sieci Adder Report Details Search Detad lepal Detads Patert Deiat nA i gt Paver Detads Al AS othe Cirwcal Data E echucte A Al other Onea Date All Crad te gt ILOT Tune G2 00 Hepertenieve diass Do you wich fo nickje paterts f 4 match is found on ary entity or only matches are found on af selected entims Higher risk gt 30 patients on the CVD at risk register Higher risk gt 30 _AddEgiy male J patients on the CVD at risk register oyo as weit ihe eli paient f a ir s frieg apk pa F be al 2 12 Identifying patien
17. ATIENT _Forename1 PATIENT Surname PATIENT House PATIENT Road PATIENT_Town PATIENT County PATIENT_Postcode Date SYSTEM Date Dear PATIENT Title PATIENT Forenamei PATIENT Surname Your recent health check You recently attended the practice for a health check would like to invite you back to the practice to talk about your test results and discuss future care Could you please contact the practice and make a routine appointment for review Many thanks for your co operation Yours sincerely 2 9 Adding Reminders to the records of patients on the CVD at risk register You can add reminders to the records of patients in the CVD ARR Group so that when their records are opened during consultation the GP is alerted to the fact that the patient is on the CVD at risk register and therefore needs the QOF CVD primary prevention metrics completed To do this complete the following steps d b Open the Reporting gt Patient Groups module of Vision Find and select the CVD ARR Group and go to the menu option Group Applications gt Reminder Group Reminder CVD ARR Cyd Al Risk Register Cvd 10 B You will get the following dialog box ye Adda sege iod manda to al patets the croup indy oret asrida of ies yore iay Se ad po Add aiminda ndividvely to sach palier j Ihs croup Thess iamindeis may be subseguenlp ediad on an indhidua oshent basi O Ranea remedias hon thes grou
18. BP recorded as 1400 85 Code CVD risk 20 into clinical Take appropriate action to address to system for each patient errors for example e Recheck patients with erroneous BP entries Send screening invitation letter e Add correct codes for patients who using mail merge facility should be on diabetes CVD registers Patients will be reviewed in next screening cycle Review patients and record data using CVD prevention template Appropriate clinical management Monitor achievement against QOF CVD prevention indicators using QOF IT tools Review patients not meeting indicators Tasks that can be completed within Oberoi QOF CVD Prevention Indicators Payment stages CVD PREVENT 1 The percentage of patients on the Practice CVD At Risk Register whose notes have a Blood Pressure 40 90 recorded in the previous 15 months CVD PREVENT 2 The percentage of patients on the Practice CVD At Risk Register whose notes have a record of BMI 40 90 measured in the previous 15 months CVD PREVENT 3 The percentage of patients on the Practice CVD At Risk Register whose notes have a baseline record of total and HDL cholesterol recorded in the previous 15 months Indicator CVD PREVENT 4 The percentage of patients on the Practice CVD At Risk Register for whom there is a record of a fasting blood glucose in the previous 15 months CVD PREVENT 5 The percentage of patients on the Practice CVD At Risk Register whose notes
19. By Appointment Mon Thu 08 00 till 09 45 or Fri 08 30 till 12 30 You need to make an appointment by calling 020 8846 6767 You will need to fast before the blood tests This means that you cannot eat or drink anything apart from water for 12 hours before your blood test You should continue to take any regular medication that you are on Please take the enclosed blood test form when you attend for your blood test We should be able to discuss the results of your blood tests when you attend for your health check appointment at the surgery If you have already responded to a previous letter inviting you to attend for a Health Check please accept our apologies for sending you this further letter If you wish to decline this invitation for a Health Check please complete and return the slip at the bottom to avoid us sending you further reminders Many thanks for your co operation Yours sincerely would like to decline this invitation for a NHS Health Check because Signed Date Name Title Forename Surname NHS Number NHS Number EMIS Sample Letter 3 Patients whose health check is satisfactory Title Calling Name Surname Patient Address Line 1 Patient Address Line 2 Patient Address Line 3 Patient Address Line 4 County Post Code Date Today Dear Title Surname Your recent health check Your Patient Number Patient Number Please quote this number if booking an appoint
20. Creating your CVD at risk register cccccccsecccseeeeseeeeseeeeseeeeseeeeseeeeseeeesees 16 2 2 Creating a single CVD at risk Patient Group ccccccceseseeeeeeeeeneeeesaeeeeees 18 2 3 Adding a button to your Primary Prevention of CVD Guideline to aid call and Call N E E PEE N E AEE AN E 20 2 4 Setting up your CVD primary prevention invite letterS ccccseseesseeeeees 22 2 5 Adding Reminders to the records of patients on the CVD at risk register 23 2 6 Generating Invite LON CIS erresen TE ERNE E 28 2 Documenting the dispatch of invite letters in patients medical records 29 2 8 Data entry during your CVD primary prevention appointments 30 2 9 Recording that patients have declined the invite ccccsseesseeseeeeeeeeneees 31 2 10 Identifying patients who need a second third invite letter cee 32 2 11 Targeung your AOL O ACM ieser rnan En EE E E EEEE E EEE 34 2 12 Identifying patients who have had a CVD Primary Prevention appointment but failed to return for fasting blood tests nennnensnnnenneenenrrrnrenrree rrene 36 Section 3 QOF processes for CVD primary prevention with EMIS LV 38 3 1 Creating your CVD at risk register cccccccseecceeeeeseeeeeeeeeeeeeeseeeeaeeeseeenees 39 3 2 Adding a code to your Primary Prevention of CVD template to aid call and PEG A e ste enue E R 40 3 3 Setting up your CVD primary prevention invite letters
21. Hammersmith and Fulham A Guide to QOF Processes for Primary Prevention of Cardiovascular Disease Quality and Outcomes Framework Plus 2008 2009 Copyright NHS Hammersmith and Fulham 2009 Copyright eHealth Unit Department of Primary Care and Social Medicine Imperial College 2009 Published by NHS Hammersmith and Fulham This publication may be reproduced and circulated by and between NHS Hammersmith and Fulham related networks and officially contracted third parties only This includes transmission in any form or by any means including photocopying microfilming recording and file transfer This publication is copyright under the Copyright Designs and Patent Act 1988 All rights reserved Outside of NHS Hammersmith and Fulham related networks and officially contracted third parties no part of this publication may be reproduced or transmitted in any form or by any means including photocopying microfilming recording and file transfer without the written permission of the copyright holder application for which should be made in writing to the following email address and marked re permission Such written permission must always be obtained before any part of this publication is stored in a retrieval system of any nature or electronically Where any of the copyright items within this publication are being republished or copied to others the source of the material must be identified and the copyright status acknowledg
22. L cholesterol level OF Type 44P6 00 Serum fasting HOL cholesterol level OF Type 44PC 00 Serum random HOL cholesterol level Hatch on all or any Do you wish to inclide patents if a match is found on any entity or only if Match Any o Aan o Ne O tch found ll selected O Ne are found on all selecte Match amp ll Close eG aro Some of the important features of the search have been highlighted in red on the screen shot If you require training on the Search and Reports module of Vision or if you require any assistance defining searches for QOF then please log a call with the IT Service Desk servicedesk hf pct nhs uk 020 8383 8655 Section 3 QOF processes for CVD primary prevention with EMIS LV 3 1 Creating your CVD at risk register Once you have identified a list of patient IDs for patients in the following two groups you can use the EMIS batch processor to enter these codes onto patients records a Patients with a 10 year CVD risk score in the range gt 20 30 Read Code 662m b Patients with a 10 year CVD risk score in the range gt 30 Read Code 662n To use the EMIS batch processor complete the following steps for each of the two cohorts above d b j Go to AO Advanced Options gt BD Batch Processing Click Y at the warning prompt Select option A Batch Data Entry When prompted to indicate how you ll be defining the list of patients to apply the batch processing to
23. PAINACSA eeqpewaten NOTE Be sure not to combine the two groups ot AAAA AOAO Dan minn reqeerted af TI given above you ll need a separate Group for Date of Hem Date per cupbed te pioc patients with risks gt 20 30 and risks gt 30 And pay careful attention that you are entering the numbers correctly gt te a fe Search Input Report Output lt a gt j4 Ke Duin wc hte f When you are finished click OK to return to the SEARCH New search screen Search Datalts 1am goto Report Dotais g Double click in the Group Output section Loup Hare bop Desonpaon ICYD 20 90 Pes wath tiyan CVD Aink 20 X Kee h Give your Group an appropriate Name and a GaN Arakea Ol Per wWiharw amp Dee ina SHOEXCOLIN Ciesa Daa Echa From Moues Queies H H H SHOENONMS Inrresora Daa E ndudad Fion Nigma Dam Description and click OK SHOEXDOLUDE Data Ewohaded From Mique Queco IMONGCTVE Pater Spaen Grog Mique rata Paterds SMORPT OO Repot On Srecking amp Bre in Pte 16 tHORPT OUR Repot On Smotesg k Brewin Pte 16 SMGAPT OOS Rapor On Smoking amp Bre ln Piz 165 SMORPT OOD Repost On Smoking t Bre in Pto 16 SHORPT OOS Refenah Repot FP eeudonwreaed SMORPT OE Retensi Repot Peeudonereecl SHUAPT OOO Pasents With oowect Gerda Codes Audi Picudo tMWORPT Os Pahari With beooceedt Gerace Cocker Qu Pim ch cod ae i Click Run The search will run and the output will go to a P
24. al judgement are appropriate for inclusion on the CVD at risk register 7 Review Risk Scores Note that the addition to a patient s medical record of a CVD risk score is a clinical decision and a clinician should be responsible and accountable for approving a list of risk scores before they get added to patients medical records How this process is performed is down to local choice but you may wish to consider the following a Do any of the risk scores look unusual or inappropriate If so investigate them before coding them An example might be a risk score that has been skewed by erroneous data in a patient s medical record e g a BP incorrectly recorded as 880 90 resulting in a CVD risk of 97 b Are there any patients identified for inclusion on the CVD at risk register who actually have diabetes or CHD but who are missing this as a diagnosis in their records If so they needn t have their CVD risk score coded instead they should have their diagnosis recorded An example might be a patient with a readcode for the procedure of a Coronary Artery Bypass Graft but without a readcode for IHD c Are there any patients who in your clinical judgement would be inappropriate to be managed as a CVD at risk patient under the QOF CVD primary prevention indicators For example a patient in the advanced stages of terminal cancer might be offended if they received an invitation to attend the surgery for screening of their 10 year CVD
25. an appointment for your Health Check Please mention that you require a Health Check to ensure you are given the correct appointment If you have already responded to a previous letter inviting you to attend for a Health Check please accept our apologies for sending you this further letter Many thanks for your co operation Yours sincerely EMIS Sample Letter 2 Inviting patient to attend for health check with prior fasting blood tests Title Forename Surname Patient Address Line 1 Patient Address Line 2 Patient Address Line 3 Patient Address Line 4 County Post Code Date Today Dear Title Forename Surname Invitation for a NHS Health Check We are inviting you to attend the practice for a NHS Health Check to see if we can help you reduce the risk of developing heart disease diabetes or having a stroke in the future This health check will include checking your weight and blood pressure Please could you contact our reception staff to arrange an appointment for a NHS Health Check We would like you to have some blood tests done at least one week before you attend your health check appointment You can have your blood test done by attending one of the following services 3 Pathology Department at Charing Cross Hospital St Dunstan s Road W6 8RF Walk in Service Mon Fri 08 30 till 16 00 No appointment needed 4 Parsons Green Health Centre 5 7 Parsons Green SW6 4UL
26. atient Group j Switch to the Reporting gt Patient Groups module of Vision k Find the Group you created above select it and go to the menu option Group Applications gt Generate History l You will get a History Add screen for entering the Read term Evert Bem Cries O _ T Peete fF Pracie m Double click in the Read Term for Characteristic field ee sm theres to launch the Read dictionary and locate the Laks ded by Oben Chrena Ohien Sule appropriate Read Term 662m or 662n Fill out the remaining options We would suggest the following Tepe of Chetactewts Epoo Tepe Proty OK Dagn i d Corrag i Event Date Should be the date you ran the Ode Oberoi extraction ii Comment Estimated by Oberoi Clinical Observations Suite iii Type of Characteristic Diagnosis iv Episode Type Continuing v Priority 1 vi End Date Leave Blank n Click OK The Read codes will be added to the patients records Note You will need to complete the above steps for both of the patient groups gt 20 30 and gt 30 Once this is done your CVD at risk register will be in place If you require assistance in creating the CVD at risk register or are having problems following the process above then please log a call with the IT Service Desk servicedesk hf pct nhs uk 020 8383 8655 Creating a single CVD at risk Patient Group The Patient Groups that you set up in the previous step were
27. choose option B Generated Manually Specify the Data Type as option A Clinical Record Identify the Read Code to be batch entered Either 662m Patients with a 10 year CVD risk score in the range gt 20 30 Or 662n Patients with a 10 year CVD risk score in the range gt 30 Click N when prompted whether to add the code as an active problem When prompted to specify the date of entry select option A The same for all the patients and accept the default date At the confirmation prompt check the details and press Y to confirm twice Identify the patients one at a time by typing their patient identifiers and pressing return WARNING Be very careful thorough when entering patient identifiers for batch processing k After identifying the final patient press F1 to return to the previous screen Your CVD at risk register is now in place If you require assistance in creating the CVD at risk register have any queries about the process or are having problems following the process above then please log a call with the IT Service Desk servicedesk hf pct nhs uk 020 8383 8655 3 2 Adding a code to your Primary Prevention of CVD template to aid call and recall To aid the call and recall processes you are advised to add the following code as a Yes No prompt into your Primary Prevention of CVD template 6C2 Primary prevention of cardiovascular disease To do this complete the following steps
28. ck the box Exclude patients with no records for this entity 6 Ensure that the Match All option is selected on your search screen 7 Double click in the Group Output field and give your search an appropriate name 8 Your search should now look as follows SEARCH New Search A a pma Fie Edit Maintenance Help Search Input Report Output view aoup aput select Group Output CVD ARR Pts With 10 vear Cyd Risk 20 4 CVDAR BLOS Pts on CVD ARR require recall for bloods iors Report Details Add Entity Search Details Report Details Patient Details P Patient Details All Ek ig All other Clinical Data All other Clinical D ata Matches Date of event Set Test results All All Lis After 30 Jun 2008 INC Search Details 3 Test results All Exclude L Lis After 30 Jun 2008 INC Read code for test OF Type 440E 00 Plasma total cholesterol level OF Type 44P1 00 Serum cholesterol normal OF Type 44P 2 00 Serum cholesterol borderline OF Type 44P3 00 Serum cholesterol raised OF Type 44P4 00 Serum cholesterol ver high OF Type 44P 00 Serum total cholesterol level OF Type 44PH 00 Total cholesterol measurement OF Type 447 2 00 Fasting blood sugar Of Type 4491 00 Plasma fasting glucose level OF Type 4471 00 Serum fasting glucose level OF Type 4404 00 Plasma H L cholesterol level OF Type 4403 00 Plasma fasting HDL cholesterol level OF Type 4402 00 Plasma random HDL cholesterol level OF Type 44P5 00 Serum HD
29. d by contacting the IT Service Desk IT Service Desk 020 8383 8655 As a rough guide 1 2 hours is likely to be adequate to demonstrate the functionality of the product in the context of QOF How can I contact Oberoi for support Oberoi support desk 01332 224 251 Direct support from Oberoi will only be provided till the year 2010 Support in using Oberoi is also available from the local IT Service Desk on 020 8383 8655 Enquiries directly related to QOF might be better directed to the local IT Service Desk than to Oberoi If want to use Oberoi on multiple workstations do need to install separate instances of Oberoi on each workstation each with a separate database of analysed data 17 No Oberoi can be installed on just one workstation as a Virtual Server which can be made accessible from any other workstation in your practice With this approach you will have only one instance of Oberoi and only one database of analysed data There is more information available about how this option is set up configured in the installation instructions available from the Documents section of the QOF intranet site http www qofplus co uk more If you wish to discuss these configuration options check how Oberoi is installed at your practice require any assistance with the installation or need any help understanding how to use Oberoi as a Virtual Server please contact the IT Service Desk IT Service Desk 0208 383 8655 Does
30. dopt for the Lipid modification guidance In addition it is expected that after screening tests are arranged clinicians will calculate an actual risk score which is then inserted into the notes as a Read code This will become the most recent risk score entry in the patient s notes which will help govern future management of that patient It is also only fair to say that Oberoi is not an ideal tool Unfortunately there is no better The F3 function key allows me to configure risk factors in Oberoi How should configure these risk factors We are advising that risk score factors in Oberoi be configured as follows 1 The risk factor associated with a Family History of CVD should be left at the default value of 1 5 2 The risk factor for all ethnic groups should be left at the default value of 1 0 This is because Oberoi versions 2 6 14 and earlier may incorrectly over estimate the CVD risk 19 for patients who have a family history risk factor and an ethnicity risk factor combined To avoid any further confusion to practices who might not be sure which version of Oberoi they are using we have suggested not to adjust the ethnicity risk factors Which existing disease register patients should not get added to the CVD At Risk Register Patients with CHD or diabetes should not be added to the CVD At Risk Register When the data from Oberoi is exported to Excel you can filter out patients with CHD or diabetes Should patients w
31. e 662m JBS CVD risk gt 20 30 over 10 years Classification Code 662n JBS CVD risk gt 30 over 10 years Classification Code 6C2 Primary prevention of SHARED 30 06 08 30 09 09 cardiovascular disease Classification Codes for Chol LDL FBG 440E Plasma total cholesterol level 44P1 Serum cholesterol normal 44P2 Serum cholesterol borderline 44P3 Serum cholesterol raised 44P4 Serum cholesterol very high 44PJ Serum total cholesterol level 44PH Total Cholesterol Measurement 4472 Fasting blood sugar 44 1 Plasma fasting glucose level 44f1 Serum fasting glucose level 44dA Plasma HDL cholesterol level 44d3 Plasma fasting HDL cholesterol level EXCLUDED 30 06 08 30 09 09 44d2 Plasma random HDL cholesterol level EXCLUDED 30 06 08 30 09 09 4A4P5 Serum HDL cholesterol level EXCLUDED 30 06 08 30 09 09 44PB Serum fasting HDL cholesterol level EXCLUDED 30 06 08 30 09 09 4APC Serum random HDL cholesterol level EXCLUDED 30 06 08 30 09 09 EXCLUDED 30 06 08 30 09 09 EXCLUDED 30 06 08 30 09 09 EXCLUDED 30 06 08 30 09 09 EXCLUDED 30 06 08 30 09 09 EXCLUDED 30 06 08 30 09 09 EXCLUDED 30 06 08 30 09 09 EXCLUDED 30 06 08 30 09 09 EXCLUDED 30 06 08 30 09 09 EXCLUDED 30 06 08 30 09 09 EXCLUDED 30 06 08 30 09 09 EXCLUDED 30 06 08 30 09 09 If you require training on the Search and Statistics module of EMIS or if you require any assistance defining searches for QOF then please log a call with the IT Ser
32. e clinical systems use differing default values for Cholesterol However Oberoi has validated the risk scores against standalone online risk calculators Which risk score Read codes are used by Oberoi and which of these are relevant to the QOF CVD At Risk Register The following risk score Read codes are used by Oberoi e 662k JBS CVD Risk lt 10 10 yrs e 6621 JBS CVD Risk 10 20 10 yrs e 662m JBS CVD Risk gt 20 30 10 yrs e 662n JBS CVD Risk gt 30 10 yrs e 3888 Framingham CHD 10 year risk Of these risk score Read codes the ones that are relevant to QOF are the two codes highlighted in bo ld these are the codes that would be used to constitute your CVD At Risk Register am not sure how feel about inserting an estimated CVD risk score into a patient s notes rather than a calculated risk score We can understand why you might feel this way However the insertion of an estimated CVD risk score gt 20 into the patient s notes helps create a virtual register of patients suitable for targeted screening This process is incorporated into the approach suggested by the Oberoi software which is used across the country Originally the software even inserted the code into the patient s notes for you On a clinical level all CVD risk calculations whether estimated or calculated are forms of estimates and are imperfect to differing degrees Indeed NICE debated a lot about which CVD risk formula to a
33. e like a condition You do not have to worry about reducing the risk and then not being paid We already thought of this possibility so the complicated QOF Business Rules address it Payment will be based on the presence of a CVD risk gt 20 code without presence on diabetes CHD register irrespective of whether there are subsequent lower CVD risk codes in the notes We also did not feel it would be fair if practices screened those CVD gt 20 did some hard work to reduce the patient s risk and then not be paid as a result of their work You may also find the answer to your question in the separate QOF FAQ document which you can obtain from http www qofplus co uk more Got a question that isn t listed here Let us know qof hf pct nhs uk
34. ed About the NHS Hammersmith and Fulham logo The NHS Hammersmith and Fulham logo is Crown copyright Logos are not covered by OPSI licensing The NHS Identity guidelines state that the NHS logo can only be used by NHS organisations or on services and information that the NHS has had some involvement in These guidelines also apply to the use of the NHS Hammersmith and Fulham logo About the QOF logo QOF QOF Plus the Plus roundel and the QOF ribbon are trademarks of NHS Hammersmith and Fulham All other trademarks are the property of their respective owners If you are interested in replicating the QOF scheme in your PCT we would be delighted to share copyright and assist with localising the scheme For permission and information please contact Josip Car josip car hf pct nhs uk If you require further information about any other aspect of QOF please contact qof hf pct nhs uk Contents Introduction Section 1 Using the Oberoi Clinical Observations Suite to identify patients appropriate for inclusion on the CVD at risk register scssseeeee 8 1 1 Using the Oberoi Clinical Observations Suite to identify patients appropriate for inclusion on the CVD at risk reQiSter ccccccceeccceeeeeeaeeeesseeeesaeeesaeeees 9 1 2 Updating your CVD at risk register cccccccsececeeeeceeeeeeeeeeeeeeeaeeesaeeesaeeeeas 14 Section 2 QOF processes for CVD primary prevention with INPS Vision 15 2 1
35. en please log a call with the IT Service Desk servicedesk hf pct nhs uk 020 8383 8655 3 5 Merging invite letters The following steps describe how to merge the invite letter that you defined in Section 3 3 to the cohort of patients identified by the search you defined in Section 3 4 a Goto WP Word Processing gt S Merge Document with Search b Navigate to the search you defined in Section 3 4 and select it Document dialog box Navigate to the Lookin ie MSwDocs on Emis1322a letter you defined in Section 3 3 and click 2 weskrule Palliative Care 94 Cardiology 3 4 Physio Open 34 Child Psych 3 Respiratory 3 Diabetes 3 4 Stop Smoking RD 4 Gastro i sray d Press N when prompted whether you B cna Gaichid mms wish to add a reference to each patient s iit gt record This is unnecessary since we will menm p be adding a Read code to document this Fies ofpe RTFFie tl Cancel in Section 3 6 if we added a reference at this stage it would not be Read coded or searchable e Atthe prompt Start from which patient press Enter f The merge will run in the background Press any key to return to the Word Processor screen g Goto menu option H Merge Search Management h Press TAB to view completed merges It is possible that you may need to wait a few moments for your merge to complete i Scroll down to your recent merge and select option O
36. encounter any problems with this process then please log a call with the IT Service Desk servicedesk hf pct nhs uk 020 8383 8655 2 11 Targeting your approach The procedures above describe how to target your entire CVD at risk register in one go using a single Patient Group You may however wish to employ a more targeted approach by breaking the register into a number of sub groups who you will target in turn The processes described in this document can easily be adapted to be applied to defined subgroups of your CVD at risk register You would need to define searches to identify each separate sub group of patients that you wish to target A few possible approaches are as follows Target all patients on the CVD at risk register right away to maximise your chances of getting to see everybody before the end of the QOF period this is the process described in this document Il Only target patients on the CVD at risk register who don t have hypertension Modify your processes for dealing with hypertensive patients in order that the QOF CVD primary prevention indicators for any hypertensive patients on the CVD at risk register are performed as part of your normal process for managing hypertensive patients This will help prevent duplication of time work for patients who are already getting recalled as part of your hypertension call and recall procedures Ill Break your CVD at risk register down into subsets in order to spread out
37. ent has this feature they will not be included in the cohort iii EITHER OR If the patient has any of the EITHER OR features they will be included in the cohort Below are definitions and screenshots of searches for the four potential approaches given above All Patients on the CVD at risk register Feature pe Piet Wipes P 70 Lah D OF be bere See feet a fiver GSE BNA 1 F 5 PGS Regutere F alerte mi oa oe fnet t oposi Gen p E A Add Foatwe Cancel Feature Insert Feature RA Code Review After Operator X View Exciusions O Alter a Date Range Feature Dete Range Currently registered regular pd Aged between IFY amd T47 Inchwemic heart disease Diabetes mellitus JRS cardvas risk gt 08 30 10yr J85 cardvase risk gt 30 10 yro Select Option lt Return gt Lf complete T owe ie uw CHATE ES PTT at Pope Peme ll Patients on the CVD at risk register who don t have hypertension Feature pe mW we Sew tre feet fe Pisa GHD exi 7 WOND Beagerhers F Aleria F Editing Search Parometers A Ade Fewhes C Cancel Fersa Insert Feetwee R Code Review Abor Operator X View Exclusions D Atera Date Range nrnmoese gt Feature Date Range A Ourrently registered reqular pd i Aged between 327 and TAY gt Ischaemic heart disease Diabetes mellitus E Hypertensive disease JRS cartivas risk gt 208 30 lOyr JSS caridveec risk 308 10 yrs opz Era urm felect Option
38. epted using the above code 2 10 Identifying patients who need a second third invite letter You will need to follow up your initial invite letter with a second third invite letter for those patients that have neither attended for an appointment nor explicitly declined the invitation You can run a search for these patients and assign them to a new Patient Group Then you can follow the same process defined above to generate a second invite letter for them and document that this has been sent to them The following instructions describe how to create a Patient Group of patients who a Are on the CVD at risk register b Have received a CVD Primary Prevention invite letter documented using the Read code 90x1 At high risk of cardiovascular disease monitoring letter invite c Have not had a CVD primary prevention appointment recorded using the Read code 6C2 Primary prevention of cardiovascular disease d Have not been excepted using the Read code 8IAC Vascular disease risk assessment declined These patients will need to be re invited 1 Goto the Reporting gt Search and Reports module of Vision and click the P New Ad hoc search button to open the SEARCH New Search window 2 Double click in the Group Input field and choose the Group CVD ARR 3 Add the All Other Clinical Data entity and define a Read Code selection of 6C2 Primary prevention of cardiovascular disease and 8IAC Vascular disease risk s Jae bidin Dea
39. erol recent test results are visible on the RHS and so that you can see whether Serum triglyc they need to have test results updated in order to qualify for the QOF Fasting glucose indicators CVD PREVENT 3 and CVD PREVENT 4 Template For Primary Prevention Of Cvd LDL Cholesterol LDL Cholesterol Serum triglyc Serum triglyc Fasting Glucose Fasting Glucose Dietary advice Health ed di 24 11 2008 Comments gym Exercise advice Health ed ex 24 11 2008 Comments see dietician Smoking status Never 19 12 2008 Comments Prompt Notes Guidance S Dietary Advice Satisfy QOF indicator CVD PREVENT 7 rerereaamee nn PARON PENENT Smoking Status Satisfies QOF indicator SMOKING 1 This prompt is included since the e indicator applies to all patients over 15 Except pt smkq Reason FAST Alc Sc Test Comments AUDIT C Alc Test Comments Last Recorded Entry Cessation advic 12 2 2009 Cessatn advisor 13 11 2008 Except pt smkg 6 points 13 11 2008 4 Score 26 1 2009 Prompt Notes Guidance Cessation Advice Smoking Referral Except pt smkg FAST Alc Sc Test AUDIT C Alc Test Except pt alc Reason Statins CVD Ass Declined Comments Satisfy QOF indicator SMOKING 2 This prompt is included since the indicator applies to all patients over 15 Can be used to except the patient from all smoking indicators both for QOF and QOF These prompt for values and allow the recording of the score of the alc
40. etter and form templates for merging using Microsoft Word To find the MSWDocs folder when saving the document you may need to navigate to a path similar to the following Regetration Stabu My Network Places gt Entire Network gt Microsoft Windows Network gt Emis1234 gt EMIS1234a MSWDocs d You will need to follow the same steps for any other merge letters you wish to send out such as 2 3 invite If you would like training on setting up merge letters forms in EMIS or if you encounter problems or require assistance setting up your merge letters then please log a call with the IT Service Desk servicedesk hf pct nhs uk 020 8383 8655 EMIS Sample Letter 1 Inviting patient to attend for health check without prior fasting blood tests Title Calling Name Surname Patient Address Line 1 Patient Address Line 2 Patient Address Line 3 Patient Address Line 4 County Post Code Date Today Your Patient Number Patient Number Please quote this number if booking an appointment Dear Title Surname Invitation for a Health Check We would like to invite you to attend the practice for a NHS Health Check to see if we are able to help you reduce the risk of developing heart disease or having a stroke in the future This health check may last up to 20minutes and will include checking your weight and blood pressure Please could you contact our reception staff to arrange
41. follows a A risk factor of 1 5 should be set for the family history adjustment b The default risk factor of 1 0 should be maintained for all ethnicity codes 4 Run Oberoi Extraction and Analysis Once risk scores have been configured in Oberoi you are ready to run the data extraction analysis To do this click the Analyse clinical data icon on the Oberoi toolbar the cog symbol J Oberoi Clinical Observations 2 5 23 EMIS LY IBS Risk Ana Fie Actions Patient Mail Merge Help BLE Risk Analysis All undiagnosed patients 32 74 You ll be prompted to agree to the User License Agreement and then you ll need to click the Analyse button to commence extraction If the analyse function fails to be able to extract data it might be because Oberoi is set up for the wrong clinical system i e EMIS Vision The clinical system setting is shown on the top bar of the window see screenshot above To select your correct system select the File System Options menu entry and then select your clinical system fro the list 5 Export Oberoi extraction to Excel You ll be presented with the main data screen in Oberoi which will show extracted patient data This screen defaults to the F5 Undiagnosed view i e patients without an existing coronary or atherosclerotic diagnosis You can toggle between a variety of views using the F5 F6 F7 and F8 function keys Before exporting data ensure that the view you are usi
42. for any other merge letters you wish to send out such as 2 3 invite If you would like training on setting up merge letters forms in Vision or if you encounter problems or require assistance setting up your merge letters then please log a call with the IT Service Desk servicedesk hf pct nhs uk 020 8383 8655 VISION Sample Letter 1 Inviting patient to attend for health check without prior fasting blood tests PATIENT Tithe PATIENT Forename1 PATIENT Surname PATIENT House PATIENT Road PATIENT Town PATIENT County PATIENT Postcode Date SYSTEM Date Dear PATIENT Title PATIENT Forenamei PATIENT Surname Invitation for a Health Check We would like to invite you to attend the practice for a NHS Health Check to see if we are able to help you reduce the risk of developing heart disease or having a stroke in the future This health check may last up to 20minutes and will include checking your weight and blood pressure Please could you contact our reception staff to arrange an appointment for your Health Check Please mention that you require a Health Check to ensure you are given the correct appointment If you have already responded to a previous letter inviting you to attend for a Health Check please accept our apologies for sending you this further letter Many thanks for your co operation Yours sincerely VISION Sample Letter 2 Inviting patient to attend for hea
43. greater than 20 In terms of Read codes it is made up of those patients who have either of the following Read codes entered into their records at least once 662m JBS CVD risk gt 20 30 over 10 years 662n JBS CVD risk gt 30 over 10 years This register will need to be set up by the practice with the aid of Oberoi software before you can commence on the QOF CVD primary prevention indicators The following steps describe how to create the CVD at risk register 1 Ensure Oberoi Clinical Observations version 2 6 17 or later is installed You will need Oberoi installed on at least one PC in your practice This might be the practice manager s PC or the PC used by the practice s QOF CVD primary prevention lead If you have it installed check that it is version 2 6 17 or later The version will be displayed at the very top of the Oberoi window when you open Oberoi Oberoi Clinical Observations V2 6 14 EMIS LV JBS Risk Analysis File Actions Patient Mail Merge Help HSE You can download the latest version of the software at htto www oberoi consulting com primaryprevention aspx RE Pe ieee gene ee Es useful for advanced data manipulation and Call Oberoi a mail merge Consulting on Fery olone 224 zalio i A copy of the Installation Instructions for your ete sito ining clinical system can be obtained by emailing adming oberoi consulting com To download the software please click Ere Latest ve
44. he above process then please log a call with the IT Service Desk servicedesk hf pct nhs uk 020 8383 8655 2 3 Adding a button to your Primary Prevention of CVD Guideline to aid call and recall You may find it useful to add a button as described below to your CVD Primary Prevention Guideline The button will be used to enter the following Read code into the patient s record 6C2 Primary prevention of cardiovascular disease This Read code will act as a flag to indicate that the patient has attended a Primary Prevention of CVD appointment This will help you search for patients on your CVD at risk register who have not attended for a CVD appointment i e who do not have this Read code 1 2 In Consultation Manager go to the menu option Guidelines gt Select Guideline Type the mnemonic QPCVDRISK press return and click View Your QOF CVD Primary Prevention Guideline will load QOF CVD Prmary Prevention Quatity Indicators CVD Risk Score Family H story Lifestyle Excarnination Investigation Prescribing QOF CYD Primary Pre X Press the Be Maintain button to switch the Guideline into edit mode The edit toolbox will appear Click on the very top row of the Guideline and then click the L Clinical Data Hotspot button on the toolbox This will enable you to define the properties of the button that you are adding to the Guideline Clinical Data Hotspot Add A Clinical Data H
45. hem or configuring them or if you require any assistance in making the modification outlined above then please log a call with the IT Service Desk servicedesk hf pct nhs uk 020 8383 8655 2 4 Setting up your CVD primary prevention invite letters In order to perform a mail merge in Vision you will need to configure your CVD primary prevention invite letters To do this complete the following steps a Goto the Utilities module of Vision and open the Word Processor b You ll be prompted to specify the type of Template that you are creating Choose Patient and click Create Template c Microsoft Word will launch with a mail merge toolbar z Insert Merge Field d Write your CVD Invite letter using the B Insert Merge Fields icon insert O Address Fields Database Fields to enter merge fields There are sample letters on the follow pages gietgs P PRACTICE BlackAddress with electronic versions available from PRACTICE Main Comm No PATIENT Title PATIENT _Forenamel http www qofplus co uk more or oe PATIENT Sex PATIENT Date_of Birth PATIENT Current _NHS_Nurnber PATIENT Mew Format WHS Number A PATIENT Old F t MHS _Mumb a When you re happy with your letter save it in the panenticHinumber PATIENT Registered GP TEMPLATES folder this will be the default location with PATIENT Rea_sP_sMP_cade PATIENT Reg GP PPA code an appropriate name a b You will need to follow the same steps
46. istered regular pd SHARED RB Aged between 32Y and 4Y SHARED Ischaemic heart disease EXCLUDED D Diabetes mellitus EXCLUDED E JBS cardvas risk gt 20 30 10yr INCLUDED F JBS cardvasc risk gt 30 10 yrs INCLUDED s At high rsk CVD mon lett invte 30 6 2008 30 9 2009HARED H Primary prevention of CVD 30 6 2008 30 9 2009XCLUDED I Vasc diseas risk assess declin 30 6 2008 30 9 2009XCLUDED If you require training on the Search and Statistics module of EMIS or if you require any assistance defining searches for QOF then please log a call with the IT Service Desk servicedesk hf pct nhs uk 020 8383 8655 3 10 Identifying patients who have had a CVD Primary Prevention appointment but failed to return for fasting blood tests You may have patients on the CVD at risk register who have attended for a CVD primary prevention appointment and have had most of the QOF CVD primary prevention indicators completed but who were asked to return having fasted to have their blood tests performed and who have failed to do so The following search definition would enable you to find patients who d Areonthe CVD at risk register e Have had a CVD primary prevention appointment recorded using the Read code 6C2 Primary prevention of cardiovascular disease f Have not had any cholesterol or FBG blood test results recorded Age 32 74 Classification Code G3 Ischaemic Heart Disease Classification Code C10 Diabetes mellitus Classific Cod
47. ith hypertension be filtered out of the list of patients that need to be added to the CVD At Risk Register No Patients with Hypertension who have a 10 year CVD Risk Score gt 20 should be added to the CVD At Risk Register and these patients will be monitored against the QOF indicators You may feel that you do not need to invite your hypertensive patients for review as your practice already has a robust recall and review system for these patients If this is the case you have the option on Oberoi to filter out the Hypertensive patients from the Excel spreadsheet However we would strongly recommend that you check if your existing review of Hypertensive patients is extensive enough to cover the QOF indicators for CVD Prevention Furthermore it should be noted that even if you choose to exclude hypertensives from your CVD Prevention call recall processes these patients still need to have their risk scores coded if they are gt 20 What are the implications for a patient having a risk score added to their medical record without being informed first It is likely that as soon as a practice enters a risk score in the patient s records that patient will be sent an invite for CVD screening so the patient is being informed Is it possible to code risk scores directly into patient records from within Oberoi Some limited functionality within Oberoi to assist with coding risk scores directly into patient records has been restored to recen
48. k Practices are advised to identify a QOF CVD primary prevention lead who can take responsibility for overseeing the processes associated with creating the CVD at risk register coordinating the associated call and recall processes and monitoring achievement We recognise the processes outlined in this guide can be time consuming and tedious We do not expect this process will continue for future QOF years as the area is rapidly developing For example EMIS introduced in March 2009 a module to estimate QRISK2 scores for all patients We anticipate that both Vision and EMIS will continue to develop improvements in their systems to permit an easier integrated approach in the future http www qofplus co uk more General Enquiries qof nhf pct nhs uk IT Support servicedesk hf pct nhs uk IT Service Desk 020 8383 8655 Guide to establishing a CVD At Risk Register using Oberoi versions 2 6 19 onwards have restored some limited functionality to Code risk scores into patients notes Establish screening protocols and nominate a clinical lead Start of screening cycle 3 6 monthly Generate list of patients with estimated CVD risk gt 20 excluding those e Who are on the diabetes or CVD registers e Who have been processed before and already have a risk coded into their clinical notes Clinician review using patient notes to identify possible data entry errors No obvious errors identified Errors identified e g
49. k Analysis All undiagnosed patients 32 74 When you export the data to Excel and apply the filters to remove patients with CHD patients with diabetes and patients with risk scores lt 20 you will need to apply a further filter on the column On Register in order to display just Blanks this will remove patients that are already on your register leaving only patients who a Don t have CHD b Don t have diabetes c Have a CVD risk gt 20 d Are not already on your CVD at risk register zlOn Register o e Sort Ascending Sort Descending fall Top 10 Custom JES cardiovascular disease risk gt 20 up to 30 ov next 10 yr on 20 Jan 2009 now of 3 pai om JES cardiovascular disease risk gt 20 up to 30 ov next 10 vr on 9 Jan 2009 JES cardiovascular disease risk gt 30 over next 10 years on 20 Jan 2009 JBS cardiovascular disease risk gt 30 over next 10 years on 9 Jan 2009 JBS cardiovascular disease risk 10 20 over next 10 years on 12 Jan 2009 oO no om ow LO LO 2 ee L A j a om These patients will then need their risk scores coded If you require training using Oberoi or are having problems following the process above then please log a call with the IT Service Desk servicedesk hf pct nhs uk 020 8383 8655 Section 2 QOF processes for CVD primary prevention with INPS Vision 2 1 Creating your CVD at risk register In the previous section you will have ide
50. lapat P reucorerneecd HDA PT OE Falend epai Pindre HDORAPT O07 Pebert Yh income Gerda Codes Gockt Prosit IDAPT Oe Potent wih moceon Gerda Codes uB Prode Cancel ttez 7 Your search should now look as follows SEARCH New Search File Edit Maintenance Help Search Input CVD ARR Pts with 10 ear Cyd Risk gt 20 search Details Selections Add Entity Search Details Report Details Patient Details All All other Clinical Data All All other Clinical Data 2 Matches ie Patient Details s AE AI other Cinical Data Exclude P Date of event Ls After 30 Jun 2008 INC Read code OF Type 6C2 00 Primary prevention of cardiovascular disease OF Type SlAC 00 Vascular disease risk assessment declined CDS All other Clinical Data 2 Date of event Lis After 30 Jun 2008 INC Read code Lor Type 9051 00 At high risk cardiovascular disease monitoring let iiil Hatch on all or any Do pou wish to include patients it a match is found on any entity or only i matches are found on all selected f Match ll entities Aun New ali Close Help Save As C Match Ary Some of the important features of the search have been highlighted in red on the screen shot You now have a Patient Group of patients that require a second invite letter You can follow the same process as in Section 2 6 and 2 7 to generate a second invite letter for them and document that this has been sent to them If you
51. lth check with prior fasting blood tests PATIENT Title PATIENT Forename1 PATIENT Surname PATIENT House PATIENT Road PATIENT Town PATIENT County PATIENT Postcode SYSTEM Date Dear PATIENT Title PATIENT Forename1 PATIENT Surname Invitation for a NHS Health Check We are inviting you to attend the practice for a NHS Health Check to see if we can help you reduce the risk of developing heart disease diabetes or having a stroke in the future This health check will include checking your weight and blood pressure Please could you contact our reception staff to arrange an appointment for a NHS Health Check We would like you to have some blood tests done at least one week before you attend your health check appointment You can have your blood test done by attending one of the following services 1 Pathology Department at Charing Cross Hospital St Dunstan s Road W6 8RF Walk in Service Mon Fri 08 30 till 16 00 No appointment needed 2 Parsons Green Health Centre 5 7 Parsons Green SW6 4UL By Appointment Mon Thu 08 00 till 09 45 or Fri 08 30 till 12 30 You need to make an appointment by calling 020 8846 6767 You will need to fast before the blood tests This means that you cannot eat or drink anything apart from water for 12 hours before your blood test You should continue to take any regular medication that you are on Please take the enclosed blood test form when you attend for
52. ment You recently attended the practice for a health check We are pleased to inform you that your tests results are satisfactory Therefore you do not need to take any further action at this time but we would advice you to have a further health check in 5 years times Many thanks for your co operation Yours sincerely EMIS Sample Letter 4 Patients whose health check is not satisfactory Title Calling Name Surname Patient Address Line 1 Patient Address Line 2 Patient Address Line 3 Patient Address Line 4 County Post Code Date Today Dear Title Surname Your recent health check Your Patient Number Patient Number Please quote this number if booking an appointment You recently attended the practice for a health check would like to invite you back to the practice to talk about your test results and discuss future care Could you please contact the practice and make a routine appointment for review Many thanks for your co operation Yours sincerely 3 4 Running a search to identify the patients you will target It is necessary to decide within your practice how you wish to target the patients that require a CVD primary prevention appointment You will then need to run a search to identify a cohort of patients to whom you wish to send invite letters A few possible approaches are as follows V Target all patients on the CVD at risk register right away to maximise yo
53. ng is either F5 View Undiagnosed or F8 View All To export the data from Oberoi to Excel press F11 Excel You may receive an error message but no data will have been lost 6 Apply filters It is necessary to apply some filters to the data in P ITE RST see Excel in order to identify patients suitable for inclusion on the CVD at risk register To apply filters to the data in Excel go to the Excel menu option Data gt Filter gt AutoFilter You ll see drop down boxes appear at the top of each of the columns in Excel These can be used to filter the 732 988 Hspevtensy F stimste z On Regter No Ma Mo Yes Mo BS caordisvasc d ata My Yes My JBS cordizvasc My Yes fly J85 cordisvast Ma Yr Na To obtain a list of patients appropriate for inclusion on the CVD at risk register apply the following filters a On the Diagnosed column apply the filter No this will remove patients who already have a diagnosis of CHD b On the Diabetes Column apply the filter No this will remove the patients who already have a diagnosis of diabetes c On the CVD column apply a custom filter to select patients with a 10 year CVD risk gt 20 S 3 Riski np 54 4 Use be regeesert ay aoh wr acter es to tepeesert any series of Ceracthers After applying your filters select the whole worksheet and copy and paste it into a new worksheet These are the patients who subject to clinic
54. ntified using Oberoi a list of patients in each of the following two groups a Patients with a 10 year CVD risk score in the range gt 20 30 Read Code 662m b Patients with a 10 year CVD risk score in the range gt 30 Read Code 662n These patients need their risk scores Read coded in order to establish your CVD at risk register You may wish to create your CVD at risk register manually by individually coding each patient within Consultation Manager This will enable you to briefly review each record before adding the risk code Alternatively for each of the two groups listed above you can follow the instructions below to set them up as a Patient Group in Vision which will enable you to bulk add the appropriate Read code to the Group You will need to create the Patient Group as the output of a search filtered on NHS number a Open the Reporting gt Search and Reports module of Vision b Click the a New Ad hoc Search button to open the SEARCH New Search window c Click on the Patient Details entity and click on Selections Hapori Output vr a na l ara feport Dutuds d Click on Current NHS Number o Coresi e Click on Add New and type in the first patient s merase Came MO Mates NHS number Keep clicking Add New and typing Epi Hot E pant in the each patient s NHS number until all of the Lunt To 120 486 S60 te Easy gt a inne Dotarea NHS numbers in your group have been added Cate I
55. ohol screening tests for the QOF indicator ALCOHOL 1 These prompts are included since the CVD at risk register is one of the registers for which the ALCOHOL 1 indicator is applicable If you decide to use only one of the two available screening tests in your practice then you might wish to delete one of these prompts from the template Health ed al 13 11 2008 Except pt alc Statin prophyla 24 11 2008 CVD Ass Declined Prompt Notes Guidance Alc intervention Satisfies the QOF indicator ALCOHOL 2 This prompt has been included since the CVD at risk register is one of the registers for which the ALCOHOL 1 indicator is applicable Except pt alc Can be used to except the patient from the QOF alcohol indicators Statins At this prompt you may choose one of the following options from the picking list Statin prophylaxis Use this if you issue the patient with a statin but note that to actually prescribe the statin you will need to switch to the prescribing screen OTC Statins Use this if the patient purchases statins over the counter at a chemist or is advised to do so Statin declined Use this if the patient is offered statin therapy but declines Statin not indicated Use this if statins are not indicated Statins contraind Use this if statins are contraindicted Statin not tolerated Use this is the patient reports an intolerance to Statins 11 AR statins Use this if the patients reports an adverse reac
56. on all or any Do you wish to include patients if a match is found on any entity or only i Match Any matches are found on all selected f Match all entities Some of the important features of the search have been highlighted in red on the screen shot k Double click on the Group Output section Group Name Group Desenption give your Group an appropriate Name e g oO 888 CVD Al Flesh Register CVO 10 Risk gt 20004 eee SIMDAN Anahit OF Plt With Are Dep in QT A CVD ARR and Description and click OK IMOEXOCUN Dinica Dala Exechatied Fiom Maquest Ourias SMOEXDMNS Intrurecations Data E ecluched Fion Migue Queries SMOEXLLUDE Data Exchatedd Fiom Maouezi Quana SMONACTVE Patent Spatem Group Migquer Inactive Pahan SMORP TOON Repat On Smobung L Brain Pts 16 SMORP TORE Repat On Smohung t Sn in Pts 16 IMOPE TOR Hepat On Smokung t Sri in Pts 166 IMDRPT OOM Repat On Smoking Bri in Pta 16 IMDPPTORE Relea Repor Pssudorgsmised MORPET OOIE Aelenrss Repor Poeudorenmed tMORFT 0007 Patients with incorect Gender Codes Audit Pseudo tMORF TORS Patients With iicorect Gender Codes udt Pseudo v oe cone oo Click Run The search will run and the output will be saved to a Patient Group m Save your search with an appropriate Title since you may need to re run it in the future to update the Patient Group If you require training on using the Search and Reports module in Vision or need any assistance with t
57. or a full formal risk assessment if their estimated 10 year risk of CVD is 20 or more This will consist of a formal clinical assessment and risk factor estimation based on the measurement of blood pressure lipids and current smoking status and taking account of other relevant factors such as family history ethnicity and social or clinical circumstances At the time of launch of QOF 2008 2009 neither EMIS nor Vision provided the full ability to estimated CVD risk of all patients as recommended by NICE Therefore this guide explains how to use additional software Oberoi Clinical Observations Suite to enable you to create a register of patients at an estimated 10 year risk of CVD of 20 and more who you can then invite for full formal risk assessment and management Section 2 of this guide assumes a familiarity with INPS Vision and an understanding of the Search and Reports module and the Patient Groups module of INPS Vision If you are not familiar with these you may wish to read the INPS Vision training guides for each of these modules which are accessible from the following site http www inps4 co uk my_vision training guides or seek support from the IT Service Desk Section 3 of this guide assumes a familiarity with EMIS LV and an understanding of the Search and Statistics module of EMIS LV If you are not familiar with these you may wish to search for some guidance from the EMIS Common Room or seek some support from the IT Service Des
58. otspot Add box will appear Complete it with j f Add Displ C Edit the following details isplay i Icon a Caption Patient attended CVD Primary Prevention Caption Command Button i A pp ointment Patient attended CVD Primary Prevention Appointme Default Read Term b Default Read Term Double click in this field to launch 6C2 00 Primary prevention of cardiovascular diseas the Read Dictionary and navigate to the 6C2 00 Primary prevention of cardiovascular disease f Single Data Entry Form f Multiple Forme Gy Recalls and Reviews Ga Referal and Requests Read code PS All other Clinical Data By All other Clinical Data c In the Vision Database Hierarchy navigate to the BB Patient Preference Drug Allergies amp Adverse Reactions Medical History area Medical and Family History o Medical History B Family History d Click OK B Absence of condition er Ot Seed i eae Press the Be Maintain button to take the Guideline out of edit __ Caneel mode Your Guideline should appear as follows with a button that can be pressed when the patient attends for a CVD Primary Prevention appointment BY QOF CVD Primary Prevention Quality Indicators jor GO C 2 lac Fa d S EE QOF CVD Primary Prevention Quality Indicators CVD Risk Score Family History Lifestyle Examination Investigation Prescribing If your QOF Guidelines have not been installed or if you encountered problems installing t
59. rsion 2 6 44 important Please DO NOT install our software on your DocMan or Comtract Server During the installation you will need to telephone Oberoi on 01332 2242451 to obtain a registration code If you want to use Oberoi on more than one PC then we would recommend select the option for a Virtual Server configuration when you are prompted during installation This results in only one instance of Oberoi but it is accessible from any PC in the practice If you are not sure whether Oberoi is installed or how it is configured at your practice or if you wish to discuss Oberoi configuration options or would like Health Informatics to oversee its installation and configuration at your practice then please log a call with the IT Service Desk servicedesk hf pct nhs uk 020 8383 8655 2 Accessing the Software Locate the Oberoi Clinical Observations icon on your and double click on it 6 desktop Oberoi Clinical Observations A window will appear as shown below asking you for a username password Username oco Password prevention o oberol We Please login User name I Login Password 3 Configure Risk Factors in Oberoi Pressing the F3 function key in Oberoi allows configuration of risk factors by which patient s scores will modified on account of their ethnicity or the presence of a family history of There is a field to enter the risk factor for family history adjustment Ethnicity risk
60. specially designed for recording the information required by QOF Note If your QOF templates have not been installed then please log a call with the IT Service Desk servicedesk hf pct nhs uk 020 8383 8655 Of the QOF templates distributed to practices there is one titled CVD Primary Prevention which is intended to allow the recording of the information necessary to perform a CVD Primary Prevention Assessment It also includes as sub templates the QOF templates for smoking and for alcohol Below are screenshots of the template with some notes and guidance on usage Template For Primary Prevention Of Cvd CVD Prevention 9 1 2009 CVD Risk 21 30 10 2 2009 FH MI ld M lt 55 23 12 2008 Father FH DM lst Deg 19 12 2008 Prompt Notes Guidance CVD Risk Assess The prompt was not included in the original distributed template Adding it to the template is described in Section 3 2 above It should be used to record that a CVD Primary Prevention appointment has been performed with the patient it is intended to simplify your call and recall procedures by being a clear marker of patients who have attended for the assessment CVD 10 yr risk It isn t intended that you would make any entry at this prompt during consultation It is included in the template so that the patient s most recent recorded risk is visible on the RHS Note that the CVD at risk register consists of people who have ever had a CVD risk gt 20 if you wan
61. t versions 2 6 19 but risk scores might still need to be entered manually into patient records using the processes shown in this guide People coded with risk more than 20 may after modification e g with a statin drop off the register because their risk drops below 20 Are you suggesting that once on the register a patient shouldn t be removed from it which would mean the code potentially becomes incorrect the day after it is added or alternatively are you suggesting that once a persons risk score drops below 20 that the code is removed and they drop off the register and the practice is not paid for this positive outcome All data entered in medical notes could be viewed as only as accurate as when it was entered We are suggesting that once a patient is on a CVD at risk register they should not 20 be removed This actually does make clinical sense as even if you reduce their risk by intervention they still need future review to monitor their risk as their risk may increase again similar approach to other chronic conditions such as diabetes CVD However we recommend that a clinician reviews the notes of the identified patients before entered the estimated CVD risk gt 20 in their notes in case there is an obvious error e g actually patient is a diabetic who has not been read coded correctly mistyped BP of 999 50 has happened at one practice etc In some ways NICE suggests viewing CVD At risk mor
62. ted to view all historical recorded risk scores press the PAGE UP PAGE DOWN keys when highlighted on this prompt to scroll through previous recorded data Press F1 to return to the template This prompt has a picking list to choose a FH CHD code that satisfies the QOF indicator CVD PREVENT 5 A family member may also be specified and comments entered if appropriate Note that if FH CHD has already been recorded it will be visible on the RHS and needn t be coded again FH Diabetes Similar to the FH CHD prompt but for FH Diabetes Satisfies the QOF indicator CVD PREVENT 6 Template For Primar Prevention Of Cvd FH Unknown Comments Systolic BP 5 12 2008 Diastolic BP 5 12 2008 j 19 12 2008 19 12 2008 19 12 2008 12 8 2008 1 8 2000 Chol HDL Ratio Chol HDL Ratio gt Prompt Notes Guidance FH Unknown For patients that have no knowledge of their family history such as people who have been adopted Systolic BP Value codes Self explanatory Satisfy QOF indicators CVD PREVENT 1 Diastolic BP and CVD PREVENT 2 O E weight O E height Note that height need only be recorded once over the age of 18 Body Mass Index Calculated field No entry necessary Cholesterol It isn t intended that you would make any entry at these prompts during HDL Cholesterol consultation as this data will normally come electronically from Pathlabs Chol HDL Ratio The prompts are included in the template so that the patient s most LDL Cholest
63. tent Variables b Microsoft Word will launch with a special EMIS toolbar Fosaa Adress ine Hneta Stress ine 2 Hosotal Adress ine J Mosotal Gddress ine 4 ae Mosotad Address ine 5 n Hosptial Number ind gt ye Feet eee tote tee eek e Da Hopal Postcode EJ i a 7 a em Pest Hosptial yongan r immur sstions Werle Gpea Td Y E EE b ao sE s d A Mecration MHotede Surnber Mothers Mame NHS Surber oA oven vatta ares Ooo sears Sete Saers FAGEN B Acn ASS ant SA NE uad HR is AE o A iT i BeerGbe ar Pre Be te eee oO it t Kame find No OF Care National GP Code Wat OF bin PIN Past Medcation Compose your CVD primary prevention invite letter Use the Mail Merge Variables Pabent Address Line I Patent Access Lire 7 button to insert merge variables into your letter such as the Patient Address Block sts ees re field the Title Initial Surname field and the Today field for the date There are sample letters below and electronic versions of these samples available from Previous Name Pratat Peat ode http www qofplus co uk more aera Date Referal Meer Referral Reason Referral Trevepert Required Ralerral Urgency Rearing Doto c When you re happy with your letter save it by going to the menu fsateschy a File Save As and then navigating to the folder MSWDocs on your EMIS server this is the location where EMIS stores l
64. tion to statins AR Simvastatin Use this if the patients reports an adverse reaction specifically to Simvastatin AR Pravastatin Use this if the patients reports an adverse reaction specifically to Pravastatin CVD Ass Declined This prompt will allow you to except a patient from the whole set of QOF CVD prevention indicators It may be used to record that a patient explicitly declined the offer of CVD primary prevention intervention i e declined to attend an appointment or be involved in the whole process If your QOF templates have not been installed or if you encountered problems installing them or configuring them or if you require training on using templates in EMIS then please log a call with the IT Service Desk servicedesk hf pct nhs uk 020 8383 8655 12 3 8 Recording that patients have declined the invite If patients explicitly decline the invitation for a CVD primary prevention appointment they may be excepted using the following Read code 8IAC Vascular disease risk assessment declined Note that a patient cannot be inferred to have declined on the basis of only one invite letter Evidence of three invite letters will be sought where a patient has been excepted using the above code 13 3 9 Identifying patients who need a second third invite letter You will need to follow up your initial invite letter with a second third invite letter for those patients that have neither attended for an appointment nor
65. ts who have had a CVD Primary Prevention appointment but failed to return for fasting blood tests You may have patients on the CVD at risk register who have attended for a CVD primary prevention appointment and have had most of the QOF CVD primary prevention indicators completed but who were asked to return having fasted to have their blood tests performed and who have failed to do so The following instructions would enable you to find patients who a Are on the CVD at risk register b Have had a CVD primary prevention appointment recorded using the Read code 6C2 Primary prevention of cardiovascular disease c Have not had any cholesterol or FBG blood test results recorded Instructions 1 Go to the Reporting gt Search and Reports module of Vision and click the 7 New Ad hoc search button to open the SEARCH New Search window 2 Double click in the Group Input field and choose the Group CVD ARR 3 Add the All Other Clinical Data entity and define a Read Code selection of 6C2 Primary prevention of cardiovascular disease and a date selection of After 30 06 08 4 Add the Test Results All entity and place a Read code selection on it for the following Read codes these are the blood test codes that qualify for QOF and a date selection of After 30 06 08 44f1 Serum fasting glucose level 5 Right click the Test Results All entity select options and switch it from include to exclude Un ti
66. ur chances of getting to see everybody before the end of the QOF period VI Only target patients on the CVD at risk register who don t have hypertension Modify your processes for dealing with hypertensive patients in order that the QOF CVD primary prevention indicators for any hypertensive patients on the CVD at risk register are performed as part of your normal process for managing hypertensive patients This will help prevent duplication of time work for patients who are already getting recalled as part of your hypertension call and recall procedures Vil Break your CVD at risk register down into subsets in order to spread out the work load over the QOF period This might help manage capacity within the practice One approach could be to target the higher risk gt 30 patients first VIII An alternative approach to the one above could be to target the higher risk gt 30 males first Whichever approach you choose to take you will need to define a search to identify the patients that need to be invited for an appointment To run a search in EMIS complete the following steps a Go to ST Search amp Statistics gt B Patient searches gt A Build and perform a new search b Select option A Perform a search on today s practice population c Build your search by adding a series of Features There are 3 types of features i SHARED The patient must have this feature be included in the cohort ii EXCLUDED If the pati
67. ut the remaining options We would suggest the following iv V vi Event Date Date the letters were generated Comment Include the body of the invite letter Type of Characteristic Administration Episode Type lt None gt Priotity 9 End Date Leave Blank e Click OK The Read codes will be added to the patients records This will enable you to easily run a search to identify patients who have received an invite letter within a particular period Make a note of the date that you assigned to the Read code this may help later when identifying patients who need a second invite letter If you encounter problems or require assistance with the process then please log a call with the IT Service Desk servicedesk hf pct nhs uk 020 8383 8655 2 8 Data entry during your CVD primary prevention appointments Practices have been provided with Guidelines specially designed for recording the information required by QOF They follow a similar format to the QOF Guidelines that you re familiar with so should be intuitive to use Below is a screenshot of the CVD Primary Prevention Guideline with some of the sections expanded Ei QOF CYD Primary Prevention Quality Indicators loj x a e SD elr lal QOF CVD Primary Prevention Quality Indicators CVD Risk Score Family History Lifestyle Reminder Rows in the table will be hidden if there is no data in them click on the top left cell to see all available rows
68. vice Desk servicedesk hf pct nhs uk 020 8383 8655 Section 4 Frequently Asked Questions about Processes for CVD Prevention What functionality does the Oberoi Clinical Observations Suite Provide The Oberoi Clinical Observations Suite extracts data from your clinical system in order to compute a variety of risk scores for patients Of the risk scores that Oberoi calculates the one that is relevant to QOF is the JBS CVD 10 year risk score Your CVD At Risk Register will be made up of those patients in the age range 32 74 who have an estimated JBS CVD 10 year risk score greater than 20 Oberoi also has a risk score calculator which may be used to experiment with the effect that modifying lifestyle serum or blood pressure factors would have on a patient s risk score Additionally Oberoi can show 5 year risk scores can summarise what data from a patient s record has contributed to their risk score and can compare their current risk with their worst case historical risk Where can find a User Manual for Oberoi Clinical Observations The Oberoi user manual is accessible from the Documents section of the QOF intranet site htto www qofplus co uk more You may also find it useful to look at the CVD Prevention section in the QOF Resource pack which you can also find at the QOF intranet site How can arrange training for practice staff on the use of Oberoi Training for practice staff on using Oberoi may be arrange
69. y vet assessment declined and a date selection of After isinin Nh Gein CV EAN 30 06 08 Right click this entity select options and switch i Eas it from include to exclude Un tick the box Exclude patients with no records for this entity Piivele hesteat Tisai code iz lupe OL Uf fren peeertecs J 1 lve aar LY gon de toor All other Clinical Data iarram Include or Exclude Criteria has been entered against this entity Do wou wish to include or exclude patents matching the criteria f Include f Exclude J Exclude patients with no records for this ertik oron s _ 4 Add a second All Other Clinical Data entity and define a Read code selection of 90x1 At high risk of cardiovascular disease monitoring letter invite and a date selection of After 30 06 08 5 Ensure that the Match All option is selected on your search screen Greup Output Goap Neve Gan Darpon IL VDAR NY P anwr epang 5 nd DI ry ut e vie DAN hrokeas DI Par WA Ar amp Dep m OI 6 Double click in the Group Output field and give your sca Dres Dss Dhsisd Fare Miei Orne e e brerarecabor Diets aizin Fron Megat Quaes r MOEMDLUDE Daa Exchates Foore Nepmii Quana search an appropriate name tMOINALCTVE Poder Sythew Ges Micquert Inaction Priori DRIP T OT Fepedt On Seek rot Gre Pie 15e Reoot On Se rg Bee Pte TE Hapat On Srtang L Ori le Pts 16 PPT O fapat Lin Seecteng k ew ia Pts The ADAPTS Ratarng f
70. your blood test We should be able to discuss the results of your blood tests when you attend for your health check appointment at the surgery If you have already responded to a previous letter inviting you to attend for a Health Check please accept our apologies for sending you this further letter If you wish to decline this invitation for a Health Check please complete and return the slip at the bottom to avoid us sending you further reminders Many thanks for your co operation Yours sincerely would like to decline this invitation for a NHS Health Check because Signed Date Name PATIENT Title PATIENT Forename1 PATIENT Surname NHS Number PATIENT Current_NHS_ Number VISION Sample Letter 3 Patients whose health check is satisfactory PATIENT Tithe PATIENT Forename1 PATIENT Surname PATIENT House PATIENT Road PATIENT Town PATIENT County PATIENT Postcode Date SYSTEM Date Dear PATIENT Title PATIENT Forenamei PATIENT Surname Your recent health check You recently attended the practice for a health check We are pleased to inform you that your tests results are satisfactory Therefore you do not need to take any further action at this time but we would advice you to have a further health check in 5 years times Many thanks for your co operation Yours sincerely VISION Sample Letter 4 Patients whose health check is not satisfactory PATIENT_ Title P

A Guide to QOF+ Processes for Primary Prevention of

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